A case of gastric bronchogenic cyst in Singapore with multiple intrigues

Abstract

A 30-year-old lady was referred for the evaluation of a cystic pancreatic mass. The initial ultrasound scan showed a cystic mass measuring 6 ¥ 3 ¥ 3 cm adjacent to the tail of the pancreas. Clinical examination was unremarkable. Subsequently, a computed tomography (CT) scan was performed and showed a 5.1 ¥ 3.6 ¥ 4.6 cm well-circumscribed cystic lesion arising from the body of the pancreas (Fig. 1). The lesion was exophytic in nature and extended superiorly to just below the left hemidiaphragm. No calcification or septation was seen. Her serum carbohydrate antigen 19-9 (CA 19-9) was also found to be elevated at 86 U/mL (0-35 U/mL).An endoscopic ultrasound (EUS), together with fine needle aspiration (FNA) of the cyst, was performed. It showed that the cyst was arising from the body/tail region of the pancreas, and it was also thin-walled and septated. The rest of the pancreas appeared normal. FNA of the pancreatic cyst yielded only a minimal amount of thick mucoid fluid and was sent for both cytological examination and analysed for tumour markers. Cytological examination revealed ciliated columnar epithelial cells with mucoid material and no malignant cells. Unfortunately, our laboratory rejected the specimen for analysis of tumour markers as the contents were deemed too gelatinous and unsuitable.In view of the size and the predisposition for malignant change, she agreed for a laparoscopic spleen preserving distal pancreatectomy. During the diagnostic laparoscopy, the cyst was actually found to be an exophytic mass arising from the posterior wall of the stomach that was resting on the anterior surface of the pancreas (Fig. 2). An on-table gastroscopy was performed to exclude any mucosal involvement and to ensure an adequate gastric capacity after laparoscopic wedge resection.Post-operatively, she recovered well and was discharged on the third post-operative day. A repeat CA 19-9 performed several months later showed that it had normalized to 32 U/mL (0-35 U/mL).Final histology found the lesion to be arising from the posterior aspect of the stomach with the cyst confined in the serosa layer of the stomach and extending into the muscularis propria. It was lined by pseudostratified ciliated columnar epithelium, consistent with respiratory epithelium and surrounded by smooth muscle, reminiscent of a respiratory bronchiole. Scattered seromucinous glands were also seen. There was also focal ulceration of the lining epithelium with Fig. 1. CT scan showing the lesion, which seemed to be arising from the pancreas.Fig. 2. Gross pathological picture showing the cyst arising from the stomach. The cyst lies inferior to the resected stomach in this picture.

Gastric bronchogenic cysts: A case report and literature review

“…In the remainder of the identified cases of gastric bronchogenic cysts, the cyst was continuous with the stomach wall or surrounded by smooth muscle that is continuous with the muscle of the stomach. With the exception of elevated CA 19–9 levels in 2 of the cases ( 8 , 22 ), other tumor markers in the majority of cases were all normal, suggesting that there are no specific tumor markers for this condition. Postoperatively, the elevated CA 19–9 levels were found to be normalized.…”

Young patient with a giant gastric bronchogenic cyst: A case report and review of literature

“…Notably, four patients with gastric BC had elevated tumor marker levels. Elevated CA19-9 levels were present in two of the patients[ 10 , 14 ], and elevated CA72-4 levels were also present in patients with elevated CA72-4 levels[ 15 , 16 ]. Interestingly, these elevated tumor markers returned to normal after surgery, suggesting that there is a direct relationship between benign BCs and elevated tumor marker levels.…”

“…However, among those who exhibited symptoms, epigastric pain and vomiting were the most prevalent[ 8 ]. Most gastric BCs are easily misdiagnosed as gastrointestinal stromal tumors (GISTs) before surgery[ 9 ]; however, fortunately, their prognosis is good[ 10 ]. In the current investigation, we have documented a rare instance of a gastric BCs occurring in a 34-year-old patient.…”

"Ultrasound Diagnosis of a Heterotopic Bronchogenic Cyst Located in the Muscularis of the Cardia"

“…After eating, the patient was prone to vomiting and nausea, which resulted in less food intake and significant weight loss, with a weight loss of 3 kg within one month. Some studies have said that the diagnosis of gastric bronchogenic cysts mainly depends on CT and MRI, but with imaging diagnosis alone, it is still difficult to differentiate from other cystic masses, and it is difficult to make correct diagnoses before operation [7]. If malignancy can be ruled out before surgery, endoscopic mucosal resection, myotomy or laparoscopic surgery can be used to reduce patient trauma [8].…”